Transradial access for cerebrovascular angiography: Evaluation of palmar collateral circulation with hand angiography and its correlation with Allen test

Abstract

Objectives: Transradial cerebral angiography (TRCA) has been introduced as an alternative technique for the transfemoral access, and its use is becoming more common in the field. In this study, we retrospectively analyzed a group of patients who received TRCA, and investigated peri-procedural measurements indicating actual hand circulation, and studied their correlation with the Allen test. Patients and methods: A retrospective review of 168 patients whom underwent TRCA between 2015 July and 2016 July, were included in this study. Pre procedural Allen test and Doppler ultrasonography for the radial artery (RA) and ulnar artery (UA) were done. Plethysmography tests as well as pulse oximetry monitoring were done before and during the procedure and intra-procedural angiography of the forearm and hand was done for assessment of palmar circulation. Results: Pre-procedural UA diameters revealed statistically significant correlation with manual Allen test results (P < 0.001, r = -0.381). The DUS RA diameters, however, did not correlate with any other pre-procedural measurements. The mean contrast filling time on forearm angiography was 3.33 +/- 1.97 s, and it showed statistically significant correlation with the capillary filling time of Allen tests (P < 0.001, r = -0.389). Conclusion: Manual Allen test results correlated with angiographic capillary filling of the distal hand circulation and pre-procedural UA diameters. Our results suggest that Allen test sufficiently represent the collateral circulation status prior to TRCA.